During the past year we have continued our work applying rapid MRI to guide simple and complex mechanical and biological interventions. We have introduced MRI catheterization into standard clinical practice at the NIH clinical center, based on our earlier careful pilot research comparison of conventional X-ray and wholly MRI guided transfemoral pulmonary artery catheterization in adults. We continue to enhance the capabilities of MRI catheterization to characterize heart function in patients. We continue to test MRI pericardiocentesis procedure in humans. We are developing new approaches to connect different heart chambers without surgery in patients with congenital heart disease. We also continue work towards direct repair of congenital heart defects on small children who otherwise might require open surgical access. We are developing other novel catheterization tools, for example, to access the aorta without surgery in patients with severe peripheral artery disease. Recently these have been tested in patients by collaborators outside the NIH. NHLBI Cardiothoracic Surgery Research Branch investigators have used our interventional MRI system and environment to further test the feasibility and utility of real-time MRI guidance for surgical transapical implantation of a custom aortic stent valve bioprosthesis in swine. Overall we have successfully developed novel applications of real-time MRI for cardiovascular treatments, and we continue to work to clinical applications of these exciting new developments.